Optics‑guided Robotic System for Dental Implant Surgery

At present,dental implant surgery mainly relies on the clinical experience of the doctor and the assistance of preoperative medical imaging.However,there are some problems in dental implant surgery,such as narrow space,sight obstruction,inaccurate positioning,and high requirements of doctors’proficiency.Therefore,a dental implant robot system(DIRS)guided by optical navigation is developed in this study,with an x-shaped tool and an irregular pentagonal tracer are designed for spatial registration and needle tip positioning strategy respectively.The coordinate system of each unit in DIRS is unified through system calibration,spatial registration,and needle tip positioning strategy.Then the surgical path is planned on the computed tomography(CT)images in the navigation software before operation.The automatic positioning method and the auxiliary positioning method can be used in the operation to achieve accurate positioning and assist doctors to complete the operation.The errors of spatial registration,needle tip positioning strategy,and the overall accuracy of the system were evaluated respectively,and the results showed that they all met the needs of clinical surgery.This study preliminarily verified the feasibility of the precise positioning method for dental surgery robots and provided certain ideas for subsequent related research.

Complications of CAD/CAM Fabricated Surgical Template for Static Computer-Aided Implant Surgery

Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the template. The purpose of this study was to summarize the complications associated with the use of surgical templates for static computer-aided implant surgery. Methods: Complications were collected during the observation period, and then their implant sites were reanalyzed with simulation software. Results: There were 104 cases during the observation period, 5 cases had complications. Mechanical complications were observed in four cases, including three cases in which the frame of the template fractured during implant placement surgery and one case in which the sleeve fell off the surgical template. In one case, there was an error in the planned position. All cases were mandibular molar cases, and all cases of frame fracture were at the free end defect site. All cases had a Hounsfield unit of more than 700 at the implant site, and some of them had a significantly small jaw opening. Conclusion: Although the spread of CAD/CAM surgical templates has made it possible to avoid problems caused by the position of the implant, it has been difficult to avoid fractures in cases of mandibular free end defects with high Hounsfield unit.

Short-term postoperative discomfort in patients receiving flapless contra open implant surgery

Purpose: The aim of this pilot study was to evaluate subjective and objective findings on short-term post-operative discomfort in patients receiving flapless implant surgery compared to traditional open flap surgery. Materials and Methods: A two-centre, prospective survey study was conducted, using a customized questionnaire. Between December 2010 and January 2012, 20 patients were consecutively included. Eleven received conventional open-flap surgery and nine received flapless surgery. Inflammatory signs, analgesic consumption and sleeping difficulties were evaluated up to seven days postoperatively. A clinical examination was made one week postoperatively. Results: Significantly less experienced swelling was noted 24 hours after flapless surgery compared to open flap surgery for patients receiving four implants or more, and at three days postoperatively for patients receiving single implants. No difference concerning sleeping difficulties, pain or analgesic consumption was found. Clinical examination one week postoperatively showed no differences in wound gaps, redness of the mucosa, or presence of pus between the groups. Conclusions: In conclusion, flapless surgery seems to have a limited effect on postoperative comfort and short-term post-operative signs of soft tissue healing compared to open flap surgery. There is a need for larger randomized trials for evaluating differences in postoperative discomfort between the two surgical techniques.

Bimanual microincision cataract surgery with implantation of the new Incise~? MJ14 intraocular lens through a 1.4 mm incision

AIM：To analyze the visual outcomes and the posterior capsule opacification（PCO）with the new Incise？MJ14intraocular lens（IOL）implanted through a 1.4 mm clear corneal incision（CCI）in patients who underwent bimanual microincision cataract surgery（B-MICS）.METHODS：Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study：40 eyes were implanted with an Incise？MJ14 IOL through a 1.4 mm CCI（group A）without enlargement of the main CCI,while 40 eyes were implanted with an Akreos？MI60 IOL with enlargement of the main CCI to 1.8 mm（group B）.Best corrected visual acuity（BCVA）,astigmatism and endothelial cell loss were evaluated before and after surgery at 7,30d and 6mo.Anterior segment-optical coherence tomography（AS-OCT）of CCI was performed at 1,3,7,30d,6 and 18mo.PCO incidence was evaluated at 18mo using EPCO 2000 Software.RESULTS：Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups;no statistically significant difference in surgically induced astigmatism（SIA）was noticed in the two groups.At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery;no statistically significant alterations were found at 1,6 and 18mo.PCO score at 18mo was 0.03±0.07for group A and 0.08±0.18 for group B（P=0.11）with no sign of central optic plate invasion in both groups.CONCLUSION：The implant of the new Incise？MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery.PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

Retaining Chorda Tympani Nerve Integrity During Cochlear Implant Surgery

INTRODUCTION Ear surgeons are increasingly concerned about protecting the chorda tympani nerve while avoiding injury to the facial nerve during cochlear implant surgery.The chorda tympani nerve is the sensory branch of the facial nerve and carries taste information and general sensation （e.g.,pain and temperature） from the anterior two-thirds of the tongue.It supplies efferent vasodilator fibers to the tongue and secretomotor fibers to the salivary glands in the floor of the mouth and parotid gland.

Severe prelenticular membrane formation on the surface of a hydrophilic acrylic intraocular lens after cataract surgery in an eye with an Ahmed valve implant

【正】Dear Sir,Iam Yong-Sun Ahn,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.Cataracts are a common problem in eyes with a glaucoma drainage device(GDD),because tube shunt surgery increases the incidence and progression of cataracts[1].An Ahmed valve,the most commonly inserted GDD,is composed of a silicone tube connected to a flat plate sewn to the sclera,and aqueous humor flows from the

One-year experience with the Cochlear^(TM) Paediatric Implanted Recipient Observational Study(Cochlear P-IROS) in New Delhi, India

Background： Currently, there is a significant lack of data concerning long-term outcomes following paediatric cochlear implantation in terms of quality of life. There is a need for a long-term, prospective study in this regard. This study aims at highlighting the preliminary results, one year post surgery of a five year prospective study. Methods： The CochlearTM Paediatric Implanted Recipient Observational Study （P-IROS） is a prospective, patient outcomes registry for routinely implanted children. The study collects data using questionnaires post-surgery and at regular intervals up to five years. Results： At our Centre, 159 cochlear implant surgery procedures were carried out between January 2014 and December 2014. Category of Auditory Performance II score increased from ‘0＇ to ‘3＇ at six months and to ‘5＇ at 12 months for children aged 0-3 years, although this was not statistically significant. However, the same trend was statistically significant for the age 3-6 year and age 6-10 year brackets. The quality of life of the child improved significantly. Analysis of communication mode revealed a statistically significant overall shift to the auditory-oral mode from total communication. Conclusion： Cochlear implantation is a life-changing intervention. The evidence in support of what it can achieve safely is clear. However, the costs associated with it raise the question if it will remain an effective option for life in all children. The Cochlear P-IROS is an attempt to answer the same over a five year period. Our study in New Delhi, so far concludes that cochlear implantation in a population with limited access to funds is very effective, one year after surgery.

Evaluation of Patients’ Experience Following Dental Implant Surgical Procedure

Background: Patient’s acceptability of dental implant prostheses may be influenced the fact that a surgical procedure is involved. Adequate relevant information by the dental professionals pre-surgery, is therefore, paramount to alleviating the fear of surgery and contribute positively to patient’s ability to cope with post-surgical experience. This study, therefore, aimed at evaluating the postsurgical experience of the dental implant patients. As against what was expected, and relate this with the information given pre surgery. Methodology: Post treatment self-completed questionnaires were administered to consented patients that had dental implants placed between July 2017 and December 2019. The surgical procedure followed the standard protocol and data related to post-surgical experience were collected one week after the surgery to obtain information on the level of pain/discomfort and amount of swelling experienced following surgery. The effect of the information on coping ability following surgery was also assessed. Data were analyzed using descriptive statistics (p value ≤ 0.05). Results: Twenty-seven patients received 44 implants to replace 48 teeth. The mean age of the patients was 45 ± 16.3 (SD) years. Teeth mostly replaced were the maxillary central incisors (39.6%). The majority of the patients 77.7% reported to experience less pain/discomfort than expected and 66.6% had less swelling than expected. While 29.6% felt they had excellent explanation of what to expect, 51.9% said they had good explanation. The post-surgical experience between males and females was not statistically significant (pain: p = 0.08, swelling: p = 0.64). However, the majority (8/12) that had good to excellent information preoperatively, had significantly less discomfort than expected. Conclusion: Positive, encouraging and satisfactory experience of patients following implant surgical procedure is related to adequate and correct information pre-surgery.

Simultaneous Upper and Lower Jaw Extractions, Autogenous Bone Augmentation and Temporary Implant Placement with Immediate Loading

Aims: We expanded the known technique for simultaneously augmenting an atrophic maxilla and placement of immediate provisional implants (IPI), followed by immediate loading by performing surgery in both jaws simultaneously. Feasibility of this new technique, implant survival and success were evaluated as well as prosthetic success. Materials and Methods: All patients undergoing simultaneous bone grafting and IPI placement with immediate loading at our institute between the 1st of June 2016 and the 30th of May 2018 were included and followed up for at least one year postoperatively. Results: 3 patients were followed for a mean period of 25.67 months (20 - 29 months). 33 IPIs were placed. All were immobile at second stage surgery without signs of infection. No provisional bridges were lost and no infections were noted. After second stage surgery, none of these 36 final dental implants were lost. There was some bone loss at one implant. In all patients, good functional and aesthetic results were obtained without any unforeseen complications. This renders the implant survival at 100% and the success rate at 97%. Conclusion: The technique is complex due to the intricate step-by-step process that is required and depends on a dedicated team to ensure a proper workflow. When performed correctly, the protocol shows good and predictable results.

Recent Advances in IOL Surgery

Tremendous progress is made in recent time in the field of Ophthalmology especially after advent of IOL implantation surgery. Recent advance in anaesthesia/lOL, designs/IOL, quotings/cantering, techniques/advances in operating microscope and advances in suture materials/needles etc. will be discussed.

The effect of cataract surgery on sleep quality:a systematic review and Meta-analysis

AIM： To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultravioletblocking clear intraocular lens（UVB-IOL） and blue-filtering intraocular lens（BF-IOL） implantation.METHODS： Electronic search was performed of PubM ed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index（PSQI）. A random/fixed-effects Metaanalysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS： Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3 mo [mean difference（MD） =-0.62, 95%CI：-1.14 to-0.11, P=0.02, I2=66%] and 3-12 mo（MD=-0.32, 95%CI：-0.62 to-0.02, P=0.04, I2=0）, respectively. Considering different intraocular lens（IOL） implantations, relative postoperative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION： This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.

Hydroxyapatite-containing PEO-coating design for biodegradable Mg-0.8Ca alloy: Formation and corrosion behaviour

In this study, the biocompatible protective coating was formed using plasma electrolytic oxidation(PEO) on bioresorbable Mg-0.8Ca alloy. The composition of the formed coating was studied using XRD, SEM-EDX analysis, and micro-Raman spectroscopy. The uniform distribution of hydroxyapatite over the thickness of protective PEO-layer was established. Using traditional(EIS, PDP, OCP) and local scanning electrochemical methods(SVET, SIET with H^(+)-selective microelectrode), the level of protective properties of PEO-layer in a biological environment(mammalian cell culture medium, MEM) was determined. It was established that modification of Mg-0.8Ca alloy surface by PEO contributes to a significant increase in the corrosion resistance of the surface layer, making it possible to control the process of material‘s biodegradation. The maximum local electrochemical activity was recorded after 72 h of testing, while for the uncoated sample,intense corrosion degradation was recorded in the first 12 min of exposure to the cell culture medium. Formation of the PEO-coating results in a twofold decrease in the corrosion current density(2.8·10^(-6)A cm^(-2)) and an increase in the impedance modulus measured at a low frequency(1.7·10^(4)Ω cm^(2)) in comparison with the uncoated material(9.5·10^(-6)A cm^(-2);8.1·10^(3)Ω cm^(2)). The mechanism of material bioresorption was established and a model for biodegradation process of Mg-0.8Ca alloy with hydroxyapatite-containing PEO-coating in MEM was proposed. Analysis of these results and comparing with others obtained by various scientific groups indicate the prospects for application of biocompatible PEO-coating on Mg-Ca alloy in implant surgery.

Details determining the success in establishing a mouse orthotopic liver transplantation model

Liver transplantation(LT)is currently the only effective treatment option for endstage liver disease.The importance of animal models in transplantation is widely recognized among researchers.Because of the well-characterized mouse genome and the greater diversity and availability of both genetically modified animals and research reagents,mouse orthotopic LT(MOLT)has become an ideal model for the investigation of liver biology,tissue injury,regulation of alloimmunity and tolerance induction,and the pathogenesis of specific liver diseases.However,due to its complicated and technically demanding procedure,the model has merely been used by only a few research groups in the world for years.For a new learner,training lasting at least a couple of months or even years is required.Most of the investigators have emphasized the importance of elaborate techniques and dedicated instruments in establishing a MOLT model,but some details are often neglected.The nontechnical details are also significant,especially for researchers who have little experience in mouse microsurgery.Here,we review and summarize the crucial technical and nontechnical details in establishing the model of MOLT based on scientific articles and our experience in six aspects:animal selection,anesthesia,perioperative management,organ procurement,back-table preparation,and implantation surgery.We aim to enable research groups to shorten the learning curve and implement the mouse LT procedure with high technical success.

Development of a Robotic Cochlear Implantation System

Traditional cochlear implantation surgery has problems such as high surgical accuracy requirement and large trauma,which cause the difficulty of the operation and the high requirements for doctors,so that only a few doctors can complete the operation independently.However,there is no research on robotic cochlear implantation in China.In response to this problem,a robotic cochlear implantation system is proposed.The robot is controlled by robot operating system(ROS).A simulation environment for the overall surgery is established on the ROS based on the real surgery environment.Through the analysis of the kinematics and the motion planning algorithm of the manipulator,an appropriate motion mode is designed to control the motion of the manipulator,and perform the surgery under the simulation environment.A simple and feasible method of navigation is proposed,and through the model experiment,the feasibility of robotic cochlear implantation surgery is verified.

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique （NLMT） coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfact on and erectile peni e measurements Th s is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, With new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer （30.8%） or the same （46.2%） as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject （96.5%） was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.